1. (a) The certification process shall only apply to those homes where the resident is living with an adult family care provider who is not a family member.
2. (b) An applicant shall apply to be certified via an application form obtained from the department’s health facilities administration entitled “Request for Certification of Adult Family Care Residence” (November 2019).

3. (c) An applicant shall request certification for any of the following reasons:

   1. (1) Certification of a new AFCR; or

   2. (2) For an existing AFCR:

      1. a. A change in the oversight agency;
      2. b. A change in physical location; or
      3. c. A request for an increase from one to 2 certified beds or a decrease from 2 to one certified bed.

4. (d) The applicant shall provide the following with the application:

   1. (1) Directions to the home;
   2. (2) Copies of all approved waivers, pending waiver requests, or both;

   3. (3) Verification from the department or local fire official that the applicant complies with all applicable state and local fire ordinances for a single or 2 family dwelling, including verification that the AFCR:

      1. a. Has smoke detectors that are:

         1. 1. Placed on every level of the AFCR;
         2. 2. Placed in every bedroom;
         3. 3. Interconnected and hardwired or a wireless system approved by the New Hampshire state fire marshal’s office; and
         4. 4. Powered by the AFCR’s electrical service;
      2. b. Has at least one ABC type fire extinguisher on every level of the AFCR;
      3. c. Is free from fire hazards; and
      4. d. Has at least one functioning carbon monoxide detector on every inhabited level of the home and in the basement;

   4. (4) An approval from the local fire official signed and dated with the following information:

      1. a. Date indicates that approval was obtained more than 90 days prior to the submission of the application;
      2. b. Verifies the street address of the proposed or existing AFCR;
      3. c. Verifies that the home complies with all state and local fire codes;
      4. d. Includes the date of the life safety inspection; and
      5. e. States the specific the number of beds for safe occupancy by AFC residents living in the proposed of existing AFCR; and
   5. (5) For AFCRs not served by a public water system, an analysis report completed within the previous 12 months by a certified laboratory that verifies the water supplied to or used in the prospective home is suitable for human consumption and in compliance with Env-Dw702.02 and Env-Dw 704.02.
5. (e) The applicant shall provide to the department a written agreement, signed by the oversight agency’s executive director, or his or her designee, that indicates that the oversight agency agrees to monitor the residence.
6. (f) The applicant and all household members living within the home shall authorize the oversight agency, pursuant to He-P 813.05, to complete a registry check in the BAAS adult registry to verify that the applicant and other adult household members do not have a non-criminal finding of abuse, neglect, or exploitation of an incapacitated adult.
7. (g) Information disclosed regarding adjudication of juvenile delinquency, as required by (c)(10)b. above, shall be confidential and shall not be released except in a proceeding involving the question of certification or revocation of a license, or pursuant to court order.

8. (h) The applicant shall mail or hand-deliver the documents to:

   Department of Health and Human Services

   Health Facilities Administration

   129 Pleasant Street

   Concord, NH 03301

9. (i) The department shall process applications in accordance with RSA 541-A:29.
10. (j) An application for an initial certification shall be deemed to be complete when the department determines that all items required in (b ), and (d)-(g) above have been received.
11. (k) If an application does not contain all of the items required by (b), and (d)-(g) above the department shall notify the applicant in writing of the items required before the application can be processed.
12. (l) All certifications issued in accordance with RSA 151 shall be non-transferable by person or location.
13. (m) A temporary certification shall be granted for 90 days, or until the certification has been approved or denied, from the date that the department receives all information required on the application form incorporated by reference in He-P 813.08(b).
14. (n) Within 90 days of the receipt of the application, the department’s health facilities administration shall complete an inspection for the purposes of determining whether the AFCR is in compliance with these rules.
15. (o) At the time of inspection, the department shall be provided with the results of criminal record checks, motor vehicle records, and BAAS adult registry checks for the applicant, adult family care provider, and all household members age 17 years or older as completed by the oversight agency, pursuant to He-P 813.05.

16. (p) If the applicant, adult family care provider, or any household member age 17 years or older has been convicted on a felony or misdemeanor, or has a substantiated complaint by a state agency, he or she shall provide to the department a written disclosure containing a list of any:

    1. (1) Misdemeanor or felony convictions, in this or any other state;
    2. (2) Adjudications of juvenile delinquency;
    3. (3) Permanent restraining or protective orders;
    4. (4) Evidence of any conduct that could endanger the well-being of the individual receiving care;
    5. (5) Findings by the department or any administrative agency in this or any other state for assault, fraud, abuse, neglect or exploitation;
    6. (6) Current investigations by any law enforcement agency;
    7. (7) Current investigations by the department for abuse, neglect or exploitation; or
    8. (8) An explanation of the circumstances surrounding disclosure of matters described in a. through g. above.
17. (q) After the inspection, if the department deems the AFCR not in compliance with these rules, the AFCR shall submit a plan of correction in accordance with He-P 813.09.
18. (r) After the inspection, if the department deems the AFCR in compliance with these rules, the department shall issue a certification to the AFCR.

Source. #8595, eff 4-1-06; amd by #9899-A, eff 3-29-11, (paras (b)-(p)); amd by #9899-B, eff 3-29-11 (para (a)); ss by #12740, INTERIM, eff 3-20-19, EXPIRED: 9-16-19 New. #12934, eff 12-6-19